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PathologyCancer Professor Adrienne M Flanagan. What is the role of the pathologist? Postmortem? Tissue diagnosis – benign vs malignant (cancer) What type.

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Presentation on theme: "PathologyCancer Professor Adrienne M Flanagan. What is the role of the pathologist? Postmortem? Tissue diagnosis – benign vs malignant (cancer) What type."— Presentation transcript:

1 PathologyCancer Professor Adrienne M Flanagan

2 What is the role of the pathologist? Postmortem? Tissue diagnosis – benign vs malignant (cancer) What type of cancer Carcinoma - epithelium Lymphoma - lymphoreticular Leukaemia – circulating malignant lymphoreticular cells Sarcoma – connective tissue / muscle (smooth & skeletal) bone, cartilage, endothelium, fibroblasts, fat, tendon/ligament

3 Diagnosis determines treatment Grade of tumour Stage of tumour Fully excised

4 What information is acquired from pathological examination? Tumour type Tumour type Tumour grade Tumour grade Tumours stage Tumours stage Excision margins Excision margins Other features of prognostic value Other features of prognostic value

5 What information is acquired from pathological examination? Tumour type Tumour type Tumour grade Tumour grade Tumours stage Tumours stage Excision margins Excision margins Other features of prognostic value Other features of prognostic value

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7 Type of tumour Benign Vs Malignant Benign Vs Malignant vs low malignant potential Macroscopic Macroscopic Microscopic Microscopic

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9 Germline Or Somatic?

10 What are the microscopic features that distinguish benign from malignant tumours? ArchitectureArchitecture Cell morphology – pleomorphismCell morphology – pleomorphism - mitotic figures

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12 Tumour type Breast carcinoma Ductal Lobular Tubular Endometrial carcinoma Endometrioid Papillary carcinoma others

13 Tumour Grade How closely a tumour resembles its tissue of origin?

14 Staging

15 Tumour Stage Extent of Disease Extent of Disease Pathological Staging: Pathological Staging:Size Lymph Node status Radiology Radiology Clinical Clinical 2cm

16 TK 185-kd transmembrane glycoprotein receptor p185 HER2 Signal 1 Signal 2 CerbB2 overexpressed in approx 25% of breast cancers Correlates with poor outcome in node+ and node- ve disease Recombinant humanised anti-Her2 monoclonal antobody [Herceptin] Cobleigh et al. J Clin Oncol 222 with metastatic disease & previous chemotherapy 9 CR, 37 PR [total 22%] Median duration of survival 13 months Toxicity Fevers, chills 4.7% cardiac dysfunction C erb B2

17 Sarcoma

18 Why is it useful to have all of this information? Prevention – screen, cervical and breast cancer Early diagnosis Choose best treatment Provide a useful prognosis

19 Ways in which pathologists can and have contributed to understanding the progression of cancer Compare outcome Identify the genetic changes which are associated with progression of disease Cancer of the large bowel

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25 Dysplasia grade 1, 2, 3 Cervical intraepithelial neoplasia Carcinoma in situ

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27 Cervical carcinoma If cancer invades less than 3mm deep from the surface, it is likely to be curable if resected (stage 1a) Less than1% of people will have lymph node deposits Stage 1b - 90% survival – still within cervix Stage II – 75% - beyond cervix Stage III – 35% - into pelvic side wall Determines treatment

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29 Polyps Typing histologically is essential Epithelial Hyperplastic Adenomatous Smooth muscle Vascular

30 NormalepitheliumHyper-proliferativeepitheliumEarlyadenomaLateadenomaCarcinomaMetastasis Loss of APCActivation of K-ras Loss of 18qDCC p53Otheralterations Fearon ER. Cell 61:759, 1990 Inter-mediateadenoma Multi-Step Carcinogenesis (eg, Colon Cancer)

31 The End


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